Bedtime levothyroxine administration is an attractive option for children with hypothyroidism

Authors

  • Devi Dayal Pediatric Endocrinology Unit, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20180584

Keywords:

Levothyroxine, alternative schedules, bedtime dosing, children

Abstract

Levothyroxine is traditionally administered before breakfast in the morning as its absorption is greater on an empty stomach as compared to a non fasting state. Current recommendations suggest that levothyroxine should be taken one half to one hour before breakfast and at least four hours before or after taking drugs that are known to interfere with absorption. However, distancing the administration of levothyroxine from food intake or interacting drugs may be inconvenient for patients with unpredictable or variable morning schedules and hence compliance with standard recommendations may be problematic. The morning schedules are even tighter in children due to the school timings with most schools beginning at 8 AM and children often having to leave for school by 7.30 AM. Thus maintaining the desired time gap between morning levothyroxine intake and the breakfast meal is often difficult for parents of children with hypothyroidism. In this regard, an alternative schedule for levothyroxine administration that avoids the morning hours is desirable for children with hypothyroidism. The study by Radhakrishnan et al, in the November-December issue of IJCP is therefore an interesting read.

References

Dayal D, Prasad R. Congenital hypothyroidism: Current perspectives. Res Rep Endocr Disord 2015;5:91-102.

Geer M, Potter DM, Ulrich H. Alternative schedules of levothyroxine administration. Am J Health Syst Pharm 2015;72:373-7.

Radhakrishnan R, Venkatasamy S, Pyarejan KS, Jayachandran K. Effectiveness of bedtime levothyroxine intake as compared to morning levothyroxine intake in children. Int J Contemp Pediatr 2017;4:1969-74.

Dayal D, Saini L, Attri SV, Singh B, Bhalla AK. Daily versus alternate-day thyroxine therapy to maintain euthyroidism in children with congenital hypothyroidism. Int J Endocrinol Metab 2013;11:e9499.

Bolk N, Visser TJ, Nijman J, Jongste IJ, Tijssen JG, Berghout A. Effects of evening vs. morning levothyroxine intake: a randomized double-blind crossover trial. Arch Intern Med 2010;170:1996-2003.

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Published

2018-02-22

Issue

Section

Letter to the Editor